Violence and coercion in psychiatric inpatient care: improved prevention through implementation of the proactive program Safewards

Violence and coercive interventions in psychiatric inpatient care are major problems that affect ward safety and security for patients and staff.

A mainly reactive approach is considered a contributing factor where de-escalation and medication is used as a response to increased aggressive patient behaviour.

It is now generally recognized that the earlier preventive measures are initiated, the less risk of escalating behaviours.Safewards is a preventive program that represents a new way to the reduction of violence and coercion.

It differs from previous programs in its’ focus on supporting a social community on wards in which patients and staff are seen as co-creators.

Safewards is used in many countries and several studies have shown very positive results.In Sweden, Safewards has recently been introduced and no scientific studies have been conducted here.

International Safewards research show several knowledge gaps which makes it difficult to draw conclusions and build evidence.

More knowledge is needed about what contributes to effective implementation and there is currently no evaluated instrument for fidelity measurement.

There is a lack of knowledge about causes for variations in preventive effects and how they may be related to implementation factors.The project aims to form the basis for a broader implementation and evaluation of Safewards in Sweden and thus contribute to a reduction of violence and coercive measures.

The project aims firstly to conduct a systematic review of implementation barriers and facilitators of the programme, and to develop and evaluate an instrument for measuring method fidelity.

In step two, a prospective intervention study is conducted where the model´s effects on violence, coercive measures and implementation outcomes are investigated.

Finally, a multiple case study is conducted that examines specific contextual factors related to successful and problematic implementation.